Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Improving Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus (SLE): The Role of Disease Control, Steroid Reduction and Smoking Cessation.

Harrison5,  Mark J., Dale1,  Nicola, Haque2,  Sahena, Shelmerdine6,  Joanna, Teh4,  Lee-Suan, Ahmad3,  Yasmeen, Bruce1,  Ian N.

Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, United Kingdom
Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester, United Kingdom
Betsi Cadwaladr University Health Board-West, Rheumatology, Llandudno, United Kingdom
Department of Rheumatology, Royal Blackburn Hospital, Blackburn, United Kingdom
Health Sciences Research Group, The University of Manchester, Manchester, UK
The Kellgren Centre for Rheumatology, Central Manchester Foundation Trust, Manchester, UK

Purpose:

Longitudinal studies of cohorts of SLE patients have shown that poor HRQoL does not change significantly over time, despite modern manegement. We aimed to describe changes over a 5-year period in a cohort of outpatient SLE patients and compare the clinical characteristics of sub-groups of patients experiencing clinically important improvement or deterioration.

Methods:

Female patients with SLE (>=4 ACR criteria) were recruited from routine outpatient clinics at 2 time points 5 years apart. At baseline and 5 years patients had a clinical assessment including the SLEDAI 2000 and SLICC damage index (SDI). Patients also completed the RAND Medical Outcome Study 36-Item Short-Form Survey version 1 (MOS SF-36), which allowed the SF-6D to be calculated, at both time points. The change in SF-6D over 5 years was assessed in relation to the minimum important difference (MID) of the measure (0.024). The characteristics of patients who experienced >MID improvement, >MID deterioration, or no change (DSF6D <=MID), were compared using the t-test and ANOVA or chi-square test as appropriate.

Results:

107 patients had SF-6D scores both at baseline and at 5 years. The mean(SD) age was 49 (9) years and mean (SD) disease duration 13 (10) years. At baseline, 15% were current smokers. The SF-6D score at baseline (n=107) was 0.62. The mean change in SF-6D over the 5-year period for the longitudinal cohort was 0.00 (SD 0.10). 39% (n=42) of patients in the cohort improved (mean 0.10) and 37% (n=40) of patients worsened (mean -0.10) by more than the MID. SLEDAI scores were significantly different across groups (p=0.001); decreasing in improved patients (-1.5), but increasing in unchanged (1.7) or worsened (2.4) patients. A higher proportion of improved patients stopped steroid treatment (27% vs 5%) or stopped smoking (15% vs 1%). Stopping smoking or steroids were both associated with important gains in SF-6D (0.07 vs -0.01, p=0.022) (0.08 vs -0.02, p=0.127) respectively. SDI scores did not differ between the groups.

Conclusions:

While the mean SF-6D scores in this SLE cohort did not change over a 5-year follow-up period, there are groups of patients who experience clinically important improvement or deterioration in HRQOL within this population. Better disease control while targeting a reduction/stopping of steroid therapy and smoking cessation all may contribute to large health gains for SLE patients.

To cite this abstract, please use the following information:
Harrison, Mark J., Dale, Nicola, Haque, Sahena, Shelmerdine, Joanna, Teh, Lee-Suan, Ahmad, Yasmeen, et al; Improving Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus (SLE): The Role of Disease Control, Steroid Reduction and Smoking Cessation. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :769
DOI: 10.1002/art.28537

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